I've had some secondhand interactions with the few that provide acute telestroke services in our area, and it has been problematic. They're out of state, and they don't have relationships with the local high-volume centers. So when something goes wrong or the patient requires services beyond what they can do from their office/home in Florida, they either 1) drop it in the poor ED physician's lap and walk away or 2) start making panicked phone calls to centers with ICUs and/or endovascular suites that are in the vicinity based on a google search.
If they're providing that service in an area where no one else is available to help, then that might still be a net positive for the patient population. If they're undercutting contract costs for local established telestroke networks to provide an inferior service, that's a net negative. And typically the local hospital is still going to be happy because it is cheap and if something goes wrong then the big referral centers will bend over backwards to help their patients anyway. I can't imagine that would be a satisfying work environment for a teleneurologist.
Outside of hyper-acute issues, however, I've heard fairly good things. Once the time pressure goes away, it matters much less whether you're familiar with the area or the physicians in it. The bigger issue I have heard about is retention and solvency for these companies, but I can't personally speak to those issues.